Key Points Question Do practitioners understand the probability of common clinical diagnoses? Findings In this survey study of 553 practitioners performing primary care, respondents overestimated the probability of diagnosis before and after testing. This posttest overestimation was associated with consistent overestimates of pretest probability and overestimates of disease after specific diagnostic test results. Meaning These findings suggest that many practitioners are unaccustomed to using probability in diagnosis and clinical practice. Widespread overestimates of the probability of disease likely contribute to overdiagnosis and overuse.

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The authors offer some comments on the advantages and possible drawbacks of using the SLICC criteria in longitudinal observational studies and clinical trials after applying and comparing them to the ACR criteria in two multinational, multiethnic lupus cohorts.

Anti-C1q performed the best of the potential biomarkers, being significantly associated with the modified SELENA-SLEDAI and with the Renal Activity Score. This study indicates the potential superior utility of anti-C1q over anti-dsDNA and other measures to track renal activity.

Monaurally measured temporal gap detection (TGD) thresholds characteristically increase as the frequency difference is increased over a range of about half an octave to an octave between two sinusoids that mark the onset and offset of the silent gap. For greater sinusoidal frequency separations, the TGD thresholds often become asymptotic. This pattern probably reflects two different processes. The first process likely reflects within-channel processing within a single auditory filter or channel. The second process is less certain, but may reflect between-channel processing of the silent gap stimulus across two or more independent frequency channels. To evaluate the hypothesis that asymptotic monaural gap detection can be explained by a simple between-channel process, TGD thresholds were measured as a function of frequency separation between a pregap sinusoid presented to the left ear (channel 1) and a postgap sinusoid, of higher frequency, presented to the right ear (channel 2). The rationale for dichotic presentation of the sinusoidal markers and gap signal followed from the fact that the gap detection task must be performed between two independent channels by combining the outputs from each channel (ear) and recovering the gap information centrally. The resulting TGD thresholds for pregap sinusoids from 250 to 4000 Hz were relatively invariant and increased only slightly with increasing marker frequency separation. The average TGD thresholds for four listeners were in the range of 30 to 40 ms, which corresponded closely with their asymptotic TGD thresholds for the same set of stimulus conditions measured monaurally. This correspondence of the two data sets supports an across-frequency, between-channel process for asymptotic monaural gap detection at marker frequency separations greater than about half an octave.

Severe systemic lupus erythematosus often requires the use of cyclophosphamide in women of reproductive age. As cyclophosphamide is generally avoided during pregnancy because of its teratogenic risk, its impact on fetal survival is poorly understood. This is a case series of lupus patients exposed to cyclophosphamide during pregnancy. We reviewed pregnancies in patients with lupus seen at a large university hospital between October 1986 and September 2003. The pregnancies were evaluated prospectively for cyclophosphamide exposure, lupus activity, and fetal outcome. Comparison was made between pregnancies with severe lupus requiring cyclophosphamide and those that did not. We identified four pregnancies with cyclophosphamide exposure. Two pregnancies were inadvertently exposed to cyclophosphamide early in the first trimester; both resulted in first trimester miscarriages. Two patients were administered cyclophosphamide for severe lupus nephritis and thrombocytopenia during the second trimester. Soon after the administration of cyclophosphamide, both pregnancies ended with fetal demise. Pregnancies exposed to cyclophosphamide for severe lupus flare resulted in a higher rate of fetal losses than pregnancies with severe lupus but not requiring the drug (100% versus 31.25%). In conclusion we present four pregnancies exposed to cyclphosphamide, each ending with pregnancy loss. Based on our experience, the survival of the fetus is strongly in doubt when cyclophosphamide is required to treat lupus in the mother.

Objectives: To examine the convergence of an aging population and a decreased availability of dental care coverage using data from the Health and Retirement Study (HRS). Methods: We calculate national estimates of the number and characteristics of those persons age 51 years and above covered by dental insurance by labor force, retirement status, and source of coverage. We also estimate a multivariate model controlling for potentially confounding variables. Results: We show that being in the labor force is a strong predictor of having dental coverage. For older retired adults not in the labor force, the only source for dental coverage is either a postretirement health benefit or spousal coverage. Conclusions: Dental care, generally not covered in Medicare, is an important factor in the decision to seek dental care. It is important to understand the relationship between retirement and dental coverage in order to identify the best ways of improving oral health and access to care among older Americans.

Early HIV-1 infection increases a child's risk for poor neurodevelopmental functioning within the first 30 months of life.